Certifying a Hospital Admission For certification review of non-emergency admissions to a hospital or psychiatric or chemical dependency facility, the participant is required to call Intracorp at 1-800-523-8739 as soon as he is advised that he may need to be hospitalized. In all cases, the call must be made as soon as possible but at least 5 days before the admission date. It is the participant’s responsibility to ensure that notification requirements are met.
Certifying Maternity Care and Hospitalization There is an exception to the 5-day advance notification rule for maternity care. Because of the need to ensure that maternity cases receive the proper case management, Intracorp should be contacted:
as soon as a pregnancy is confirmed, and no later than the 4th month of pregnancy, and
within 48 hours of admission for delivery.
Intracorp must also be contacted in the following instances:
if the newborn requires additional hospital days beyond the mother’s length of stay, or
if the mother is not a Plan participant but the child will be enrolled in the Plan.
For instructions on adding a newborn as a dependent, see Special Enrollment Period for Newly Acquired Dependents.
Certifying an Emergency Hospital Admission Intracorp must be notified within 48 hours of an emergency admission to a hospital. If the participant is unable to make the call, another party can make the call on the participant’s behalf. However, it is the participant’s responsibility to ensure that notification requirements are met.
Notification Requirements For Inpatient Hospital Admissions
Type of Admission
As soon as possible, but at least 5 days prior to admission Within 48 hours of admission Within 48 hours of admission
Weekend and holiday admissions must also be reported within these timeframes.
If the notification requirements are not met and the inpatient admission is later found to be medically necessary by Intracorp, penalties will be imposed.